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Four-year evolution of insulin regimens, glycaemic control, hypoglycaemia and body weight after starting insulin therapy in type 2 diabetes across three continents

Lookup NU author(s): Emeritus Professor Philip Home

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Abstract

Aims: It is of interest to understand how insulin therapy currently evolves in clinical practice, in the years after starting insulin in people with type 2 diabetes. We aimed to describe this evolution prospectively over 4 years, to assist health care planning.Methods: People who had started any insulin were identified from 12 countries on three continents. Baseline, then yearly follow-up, data were extracted from clinical records over 4 years.Results: Of the 2999 eligible people, 2272 were followed over 4 years. When starting insulin, mean (SD) duration of diabetes was 10.6 (7.8) years, HbA1c 9.5 (2.0)% (80 [22] mmol/mol) and BMI 29.3 (6.3) kg/m(2). Initial insulin therapy was basal 52%, premix 23%, mealtime + basal 14%, mealtime 8% and other 3%; at 4 years, 30%, 25%, 33%, 2% and 5%, respectively, with 5% not on insulin. Insulin dose was 20.2 U/day at the start and 45.8 U/day at year 4. There were 1258 people (55%) on their original regimen at 4 years, and this percentage differed according to baseline insulin regimen. HbA1c change was -2.0 (2.2)% (-22 [24] mmol/mol) and was similar by final insulin regimen. Hypoglycaemia prevalence was <20% in years 1-4. Body weight change was mostly in year 1, and was very variable, mean +2.7 (7.5) kg at year 4.Conclusion: Different insulin regimens were started in people with differing characteristics, and they evolved differently; insulin dose, hypoglycaemia and body weight change were diverse and largely independent of regimen. (C) 2015 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Publication metadata

Author(s): Home PD, Dain MP, Freemantle N, Kawamori R, Pfohl M, Brette S, Pilorget V, Scherbaum WA, Vespasiani G, Vincent M, Balkau B

Publication type: Article

Publication status: Published

Journal: Diabetes Research and Clinical Practice

Year: 2015

Volume: 108

Issue: 2

Pages: 350-359

Print publication date: 01/05/2015

Online publication date: 23/01/2015

Acceptance date: 18/01/2015

ISSN (print): 0168-8227

ISSN (electronic): 1872-8227

Publisher: Elsevier

URL: http://dx.doi.org/10.1016/j.diabres.2015.01.030

DOI: 10.1016/j.diabres.2015.01.030

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